Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR)

Brugel, L.; Laurent, Marie; Caillet, Philippe; Radenne, Anne; Durand‐Zaleski, Isabelle; Martin, Michel; Baron, Melany; Kermadec, H. De; Bastuji‐Garin, Sylvie; Canouï‐Poitrine, Florence; Paillaud, Éléna

doi:10.1186/1471-2407-14-427

Cited by 61 publications

(32 citation statements)

References 35 publications

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“…The EGESOR trial (NCT02025062) is obtaining baseline GA prior to any HNSCC treatment for adults age ≥65 years. 33 This is one of the largest studies to date evaluating baseline GA and how it may be associated with IADL impairments and other geriatric-oriented outcomes over time following HNSCC treatment. The same GA is serving as the baseline for the three ELAN trials: FIT (NCT01864772); UNFIT (NCT01884623); and RT (NCT01864850).…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…In oral cavity and pharynx cancers, the SEER database from 2006 to 2012 revealed 5-year overall survival of 69 and 56% for patients younger and older than 65 years, respectively (4). Other factors that may have contributed to such difference in outcomes include serious age-related comorbidities and individual decisions to avoid receiving full-dose regimens (29). This is in accordance with the results of a long-term prospective observational study of 266 subjects showing that chronological age has no independent prognostic value as opposed to comorbidities and non-standard treatment (30).…”

Section: How To Approach An Elderly Patient With Head and Neck Cancermentioning

confidence: 99%

Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

Szturz

Vermorken

2016

Front. Oncol.

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The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people, and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants. The situation is even more challenging in the recurrent and/or metastatic setting, where usually only palliative measures are employed. Nevertheless, it is becoming clear that, if treated irrespective of chronological age, fit elderly patients in a good general condition and with a low burden of comorbidities may derive a similar survival advantage as their younger counterparts. Despite that, undertreatment represents a widespread phenomenon and, together with competing non-cancer mortality, is suggested to be an important cause of the worse treatment outcomes observed in this population. Due to physiological changes in drug metabolism occurring with advancing age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70 years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomized trial conducted in lung cancer showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who needs such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We, therefore, conclude that also in SCCHN, the application of elderly specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted.

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“…The median age of HNSCC diagnosis is 63.2 years, but the cancer population, including HNSCC, is aging . The elderly represent a distinct subset of cancer patients with unique demographics, comorbidities, concerns, preferences and responses to treatment . Despite this background, elderly cancer patients are rarely the focus of research or included in clinical trials .…”

Section: Introductionmentioning

confidence: 99%